Kook D, Wolf A, Neubauer A S, Haritoglou C, Priglinger S G, Kampik A, Ulbig M W
Augenklinik der Ludwig-Maximilians-Universität, Mathildenstrasse 8, 80336, München, Germany.
Ophthalmologe. 2008 Feb;105(2):158-64. doi: 10.1007/s00347-007-1561-6.
Intravitreal injection of the antibody bevacizumab is unofficially becoming more and more the "standard of care" in the treatment of neovascular AMD. After initial concerns about possible systemic adverse events of the drug, intravitreal injection has as yet shown a very good safety profile. Due to the common application of this VEGF inhibitor it is of great importance to report complications that may be related to the use of bevacizumab. In this scope we present a series of patients with predominantly serous detachment of the retinal pigment epithelium (PED), who developed a tear (rip) in the retinal pigment epithelium (RRPE) after intravitreal application of bevacizumab.
Our data are based on a prospective, consecutive, interventional case series of 420 patients with neovascular AMD. These patients received at least 1 intravitreal application of 1.25 mg bevacizumab within the period of 1 year. Follow-up examinations were every 4-6 weeks. Visits were documented with best corrected visual acuity according to the ETDRS standard, biomicroscopy of the retina, intraocular pressure measurement, evaluation of central retinal thickness, fluorescein angiography and fundus photography.
Of 420 patients, 74 were classified as having predominantly serous PED. In the further course 13 out of 74 patients developed RRPE. Patients who had an intact subfoveal RPE, gained vision scores of 1.4+/-8.3 ETDRS letters (span width -15 to 14) despite RRPE or had stable Snellen vision of 0.0+/-0.1 logMar. In contrast patients with no subfoveal RPE due to RRPE showed loss of vision of -6.2+/-7.2 ETDRS letters (span width -15 to 1).
This case series describes RRPE as a novel complication of intravitreal anti-VEGF therapy with bevacizumab. However, it seems that this complication is limited to the entity of predominantly serous PED. These patients should therefore be informed about the risk of RRPE before initiating anti-VEGF therapy with bevacizumab, although the reverse conclusion to generally exclude patients with PED from anti-VEGF therapy is not justifiable due to therapeutic efficiency and associated gain of vision.
玻璃体内注射抗体贝伐单抗在治疗新生血管性年龄相关性黄斑变性（AMD）方面正非官方地越来越成为“治疗标准”。在最初对该药物可能的全身不良事件存在担忧之后，玻璃体内注射迄今已显示出非常好的安全性。由于这种血管内皮生长因子（VEGF）抑制剂的广泛应用，报告可能与使用贝伐单抗相关的并发症非常重要。在此范围内，我们报告了一系列主要为视网膜色素上皮浆液性脱离（PED）的患者，他们在玻璃体内注射贝伐单抗后视网膜色素上皮（RRPE）出现了撕裂。
我们的数据基于420例新生血管性AMD患者的前瞻性、连续性、干预性病例系列。这些患者在1年内至少接受了1次1.25 mg贝伐单抗的玻璃体内注射。随访检查每4 - 6周进行一次。根据ETDRS标准记录最佳矫正视力、视网膜生物显微镜检查、眼压测量、中心视网膜厚度评估、荧光素血管造影和眼底摄影等检查结果。
420例患者中，74例被归类为主要为浆液性PED。在后续过程中，74例患者中有13例发生了RRPE。黄斑中心凹下视网膜色素上皮完整的患者，尽管发生了RRPE，但视力得分提高了1.4±8.3 ETDRS字母（范围 - 15至14），或Snellen视力稳定在0.0±0.1 logMar。相比之下，由于RRPE导致黄斑中心凹下无视网膜色素上皮的患者，视力下降了 - 6.2±7.2 ETDRS字母（范围 - 15至1）。
本病例系列将RRPE描述为玻璃体内注射贝伐单抗抗VEGF治疗的一种新并发症。然而，这种并发症似乎仅限于主要为浆液性PED的情况。因此，在开始使用贝伐单抗进行抗VEGF治疗之前，应告知这些患者RRPE的风险，尽管由于治疗效果和相关的视力改善，一般排除PED患者接受抗VEGF治疗的相反结论是不合理的。
